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      Parent-reported child’s close contact with non-household family members and their well-being during the COVID-19 pandemic: A cross-sectional survey

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          Abstract

          In England (UK), at the start of the COVID-19 pandemic the public were required to reduce their physical contacts to slow the spread of COVID-19. We investigated the factors associated with children having: 1) close contact with family members from outside their household (‘non-adherent behaviour’); and 2) low well-being (Revised Child Anxiety and Depression Scale). We conducted an online cross-sectional survey, completed at any location of the participant’s choice between 8 and 11 June 2020 in parents (n = 2,010) who were aged eighteen years or over and had a school-aged child (4–18 years old). Parents reported that 15% (n = 309) of children had non-adherent contact and that 26% (n = 519) had low well-being. We used a series of binary logistic regressions to investigate associations between outcomes and child and parent characteristics. Children had higher odds of having non-household contact when they had special educational needs [adjusted odds ratio, 2.19 (95% CI, 1.47 to 3.27)], lower well-being [2.65 (95% CI, 2.03 to 3.46)], were vulnerable to COVID-19 [2.17 (95% CI, 1.45 to 3.25)], lived with someone who was over 70 years old [2.56 (95% CI, 1.55 to 4.24)] and their parent had low well-being [1.94 (95% CI, 1.45 to 2.58)]. Children had higher odds of lower well-being when they had special educational needs [4.13 (95% CI, 2.90 to 5.87)], were vulnerable to COVID-19 [3.06 (95% CI, 2.15 to 4.36)], lived with someone else who was vulnerable to COVID-19 [2.08 (95% CI, 1.64 to 2.64)], or lived with someone who was over 70 years old [2.41 (95% CI, 1.51 to 3.83)]. Many children came into contact with non-household family members, mainly for childcare. Factors relating to COVID-19, children’s well-being and education were also important. If school closures are needed in future, addressing these issues may help reduce contact.

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          Risk and resilience in family well-being during the COVID-19 pandemic.

          The COVID-19 pandemic poses an acute threat to the well-being of children and families due to challenges related to social disruption such as financial insecurity, caregiving burden, and confinement-related stress (e.g., crowding, changes to structure, and routine). The consequences of these difficulties are likely to be longstanding, in part because of the ways in which contextual risk permeates the structures and processes of family systems. The current article draws from pertinent literature across topic areas of acute crises and long-term, cumulative risk to illustrate the multitude of ways in which the well-being of children and families may be at risk during COVID-19. The presented conceptual framework is based on systemic models of human development and family functioning and links social disruption due to COVID-19 to child adjustment through a cascading process involving caregiver well-being and family processes (i.e., organization, communication, and beliefs). An illustration of the centrality of family processes in buffering against risk in the context of COVID-19, as well as promoting resilience through shared family beliefs and close relationships, is provided. Finally, clinical and research implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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            An ultra-brief screening scale for anxiety and depression: the PHQ-4.

            The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.
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              Principles of confounder selection

              Selecting an appropriate set of confounders for which to control is critical for reliable causal inference. Recent theoretical and methodological developments have helped clarify a number of principles of confounder selection. When complete knowledge of a causal diagram relating all covariates to each other is available, graphical rules can be used to make decisions about covariate control. Unfortunately, such complete knowledge is often unavailable. This paper puts forward a practical approach to confounder selection decisions when the somewhat less stringent assumption is made that knowledge is available for each covariate whether it is a cause of the exposure, and whether it is a cause of the outcome. Based on recent theoretically justified developments in the causal inference literature, the following proposal is made for covariate control decisions: control for each covariate that is a cause of the exposure, or of the outcome, or of both; exclude from this set any variable known to be an instrumental variable; and include as a covariate any proxy for an unmeasured variable that is a common cause of both the exposure and the outcome. Various principles of confounder selection are then further related to statistical covariate selection methods.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 October 2023
                2023
                19 October 2023
                : 18
                : 10
                : e0292344
                Affiliations
                [1 ] Department of Psychological Medicine, King’s College London, London, United Kingdom
                [2 ] NIHR Health Protection Research Unit in Emergency Preparedness and Response, Bristol, United Kingdom
                [3 ] Department of Psychology, University of Sheffield, Sheffield, United Kingdom
                [4 ] Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, United Kingdom
                [5 ] Trustee at Weald of Kent Grammar School, Tonbridge, Kent, United Kingdom
                University of Eswatini, SWAZILAND
                Author notes

                Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: G.J.R., R.A. and L.S. participate in the UK’s Scientific Advisory Group for Emergencies, or its subgroups. RA is an employee of the UK Health Security Agency, which is an arm of the UK Government. This does not alter our adherence to PLOS ONE policies on sharing data and materials. These groups did not fund the study or authors.

                Author information
                https://orcid.org/0000-0003-2440-3210
                Article
                PONE-D-23-01008
                10.1371/journal.pone.0292344
                10586646
                37856464
                6dccd3bc-9a3a-4299-8b08-6c82e569cd65
                © 2023 Woodland et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 January 2023
                : 18 September 2023
                Page count
                Figures: 0, Tables: 6, Pages: 21
                Funding
                Funded by: Economic and Social Research Council
                Award ID: ES/P000703/1
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000272, National Institute for Health and Care Research;
                Award ID: NIHR200890
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000272, National Institute for Health and Care Research;
                Award ID: NIHR200890
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000272, National Institute for Health and Care Research;
                Award ID: NIHR200890
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000272, National Institute for Health and Care Research;
                Award ID: NIHR200890
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000272, National Institute for Health and Care Research;
                Award ID: NIHR200890
                Award Recipient :
                Funding: This study was funded by the Economic and Social Research Council [grant number ES/P000703/1] and by the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response [grant number NIHR200890], a partnership between the UK Health Security Agency, King’s College London and the University of East Anglia. The views expressed are those of the author(s) and not necessarily those of the NIHR, UKHSA or the Department of Health and Social Care. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising Role of the funding source: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                Social Sciences
                Sociology
                Education
                Schools
                Biology and Life Sciences
                Psychology
                Behavior
                Parenting Behavior
                Social Sciences
                Psychology
                Behavior
                Parenting Behavior
                Social Sciences
                Sociology
                Human Families
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Social Sciences
                Economics
                Labor Economics
                Employment
                Custom metadata
                The data set and survey questions related to this study can be accessed via the King’s College London research data repository, KORDS (DOI 10.18742/21757232). For further information contact: kcl - research.data research.data@ 123456kcl.ac.uk .
                COVID-19

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